Tagged "sippy cup"

Ask A Therapist: 7 year old with Down Syndrome who can't drink

Posted by Deborah Grauzam on

My son who has Down Syndrome will be seven next month and still can't drink.


Ben had a high palate and was breastfed. He really latched with his tongue. He only drinks from a hard spout sippy cup. He grinds his teeth really bad too. But he still uses his tongue, even as he drinks from the sippy cup. You can see his tongue out on the bottom of the sippy cup, it's like his sucking reflex is so strong his brain won't let him not use his tongue to suck! He doesn't stick his tongue out and it's not a thick tongue either. We have tried the honey bear and tubing as well, he just wants to use his tongue! Any suggestions on how to help my little guy?


Thank you!



Hi Robin,

It sounds like your son is still demonstrating what we call a "suckle pattern" when drinking. If he is not able to drink from the honey bear straw cup at all, I would recommend that you consult a TalkTools Trained Therapist to have an evaluation and get more information on how to work on straw drinking with your child. There is a strategy of using a syringe to place small amounts of liquid in his cheeks by his back molars but I feel this technique would be best implemented by someone with experience, who can guide you through the process. If that is not an option, I would watch Sara Rosenfeld-Johnson's video-on-demand "A Three-Part Treatment Plan for Oral Placement Therapy" and try to teach yourself before implementing the techniques with your son. Please let me know if we can help you with anything else.




Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask a Therapist: Tongue Placement

Posted by Deborah Grauzam on

Hi, I am hoping you can offer a suggestion.

I am an SLP and see a 2 YO child who began sucking on his tongue and had a forward tongue posture before I started seeing him. Once I started working with him I had the family switch to straws only and eliminated the sippy cup. They did that and he continued to have tongue sucking behaviors. Now, he has switched to twisting/turning his tongue around his mouth and it is interfering with his speech sound productions.

I tried to introduce vibration to provide sensory stimulation, but he does not tolerate that in his mouth. I also gave him a chewy tube as a substitution and he will tolerate it, but it is not eliminating the problem.

Do you have any product suggestions? I would greatly appreciate it. He has no drooling, no muscle weakness, and no feeding difficulties. I have never seen a child do this before.

Thank you in advance for any suggestions or product recommendations!

I have a few thoughts on this to help you:

1. Make sure there is not a structural or physiological problem, for example enlarged tonsils and adenoids. If the tongue must be displaced forward for breathing for example it could start these odd habits. Look for a tongue tie.

2. The sensory-motor systems cannot be separated. Though you say there are no feeding issues, I suspect there may be some breakdown in oral-motor development. Look carefully at developmental norms. This will soon be available in the feeding book Lori and I wrote, or you can look into taking Lori's feeding class if you have not already. If this child sucks his tongue at rest, there may be similar patterns on the straw.

3. Use of chewy tubes and sensory motor activities are most useful when you work from the outside of the mouth to the inside of the mouth and the therapy is led by the therapist. So I would not recommend handing the chewy tube to the child, but rather follow Lori's pre-feeding Chewing Hierarchy.

4. Finally, for the tongue sucking, I would recommend tasks that work on tongue retraction. The TalkTools Straw program and TalkTools Horn program, when executed by the directions on the tools kits would be excellent, as would TalkTools Bubble Kit. If you wanted to learn more, we have self-study courses for each of these kits!

Thanks for your interest in TalkTools!

Robyn Merkel-Walsh

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